Care Management Consultant II (GMG)

Genesis Healthcare System – Care Management Consultant Job Summary The Care Management Consultant functions to ultimately assist patients through the healthcare system by acting as a patient advocate and navigator. The Care Management Consultant creates longitudinal personalized care plans for patients, collaborates with and coordinates the efforts of providers across the continuum and increasingly uses data analytics to manage the health of populations. Essential Responsibilities Transitional & longitudinal care planning and execution Conduct assessments of patient/family needs by coordinating input from all health professionals and formulating a documented plan assuring continuity of care for the highest risk patients. Coordinate continuity of patient care with patients and families following hospital admission, discharge and ER visits. Delegate care based on situation while assuming accountability for patient outcome. Support assistive personnel; serve as resource and hold them accountable for delegated tasks. Lead and coordinate activities of interdisciplinary treatment team required to make high risk clinical, benefit and network decisions. Communication & coordination between care settings Identify appropriate providers, facilities, external healthcare organizations throughout the continuum of care and communicate with interdisciplinary team to develop and maintain positive working relationships. Act as a coordinator and manager of a defined health population across multiple care settings. Coordinate care across the continuum to assure appropriate utilization of clinical and community resources. Collaborate with primary care practices to offer individualized assistance for improving and maintaining quality patient care. Guide development of multiple health care partnerships to achieve positive health effect. Ensure transitions of care are completed for assigned patients and the patient has appropriate resources to improve outcomes and prevent readmissions. Explain system-wide care management to patients and ensure they know how to reach you with questions or concerns. Consider the patient’s goals and preferences when developing the patient’s system-wide care plan. Utilization management & data analytics Manage high-risk patient care, including patients with multiple co-morbidities or high risk for readmission, using a patient registry when appropriate. Participate in data collection, health outcomes reporting, clinical audits and programmatic evaluation as needed. Analyze data to identify under/over utilization; improve resource consumption; promote cost reduction; and enhance quality of care. Assist with ongoing review/readmission root cause analysis and action plan development for assigned population of patients. Skills Required Excellent communication skills (oral and written) Excellent customer service skills Proven leadership skills Ability to work independently, setting priorities efficiently Ability to work effectively in a team environment Highly organized and detail-oriented Ability to perform multiple tasks Effective behavioral and educational strategies (motivational interviewing, teach-back, self-management support) Confidence to communicate and outreach to community health care organizations and personnel Ability to use sound judgement, decision-making and problem-solving Qualifications Level 1 – Current Ohio RN licensure, Licensed Social Worker (LSW) or Counselor (LPC) in Ohio. If RN, must also have ADN with 3 years of clinical RN experience. If LSW or LPC, Bachelor’s degree in Social Work. Strong analytical, data management and computer skills. Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. Level 2 – Current Ohio RN licensure. Must also have ADN with 3 years of clinical RN experience. Three years clinical experience and 2+ years of CM/UR/Navigator/Coordinator/leadership experience or Case Management Certification or approved alternate certification. Demonstrated leader skills, mentor, motivator, project management skills. Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. Understanding of pre-acute and post-acute venues of care and post-acute community resources. Level 3 – Current Ohio RN licensure. Must also have ADN with 3 years of clinical RN experience. Three years RN clinical experience and 5+ years of CM/UR/Navigator/Coordinator/leadership experience or Case Management Certification or approved alternate certification. Demonstrated leader skills, project management skills, and experience with creating and managing KPIs, developing or leading projects. Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. Understanding of pre-acute and post-acute venues of care and post-acute community resources. Care Management Level Grid Care Management Consultant Level I – Participates in committee activity, member of committees, provides input on performance improvement initiatives for the SWCM team, participates in case audits or studies related to care system improvements. Care Management Consultant Level II – Participates in committee activity, provides input on performance improvement initiatives, leads performance improvement initiatives, provides case study information to the SWCM Team, mentors, trains, and provides leadership to the team. Care Management Consultant Level III – Leads project work, provides mentorship, training and leadership to the team, and leads performance improvement initiatives. Physical Requirements Must be able to hear, speak, see and coordinate motor skills; climb, lift 25 pounds, stoop and bend. Ability to collect data, interpret findings, set priorities and carry out established plan. Ability to read, write and use manual and computerized documentation systems. Must read a significant amount of information in a relatively short period of time. Genesis is committed to being an equal opportunity employer. Selection of applicants for employment is based only on qualifications and the requirements of a specific job. Our mission is to provide compassionate, quality healthcare. #J-18808-Ljbffr